Release and Discharge Mechanics' Lien Form

RELEASE AND DISCHARGE OF MECHANIC’S LIEN

TO: The Clerk of the County of      , State of New York, and all others interested.

PLEASE TAKE NOTICE, that      , Lienor, had and claimed a Mechanic’s Lien pursuant to

the Lien Law of the State of New York, which Lien was filed with the Office of the Clerk of the

County of       on      , 20      against the real property known as       and designated

as tax block      , lot no.      , a copy of which Lien is annexed hereto.

PLEASE TAKE FURTHER NOTICE, that      , Lienor hereby consents to the release and

discharge of the aforesaid Mechanic’s Lien and directs that the Clerk of the County of      

discharge said Mechanic’s Lien of record.

Dated:      , New York